Dark circles under the eyes

Author: Brian Wu PhD. MD Candidate, Keck School of Medicine, Los Angeles, USA; Chief Editor: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, July 2015.


What are dark circles under the eyes?

Dark circles under the eyes describes a common appearance of the lower eyelids that has various causes. The dark appearance can be due to:

  • Increased pigmentation (melanin)
  • Loss of fatty tissue in the eyelid or around the eye
  • Bulging fat and muscle loss
  • Puffy eyelids
  • Thin, translucent skin
  • Shadowing due to anatomic shape of the orbit

The appearance can be challenging to treat.

Who gets dark circles under the eyes?

Those prone to dark circles under the eyes include:

  • The elderly (but they are also a common complaint in adolescents)
  • People of non-white ethnic background
  • People with a genetic predisposition to dark circles under the eyes

What causes dark circles under the eyes?

Pigmentation under the eyes is associated with dermal deposition of melanin. Dermal melanin deposition is often due to post-inflammatory pigmentation, which may follow:

Loss of fatty tissue in the eyelid or around the eye (tear trough) is associated with:

Bulging or puffy eyelids may be due to systemic conditions, particularly:

Thin translucent skin is commonly observed with:

  • Age
  • Genetic factors

Shadowing is more noticeable at times, due to:

  • Fatigue or lack of sleep
  • Periorbital oedema (puffy eyelids)
  • Dehydration (sunken eyes)

Superficially located blood vessels and blood stasis may contribute to the darkened appearance.

How are dark circles under the eyes diagnosed?

Correct diagnosis of dark circles under the eyes can be difficult. It involves:

  • Personal, medical and family history
  • Physical examination
  • Wood lamp evaluation, which allows the clinician to assess depth of pigmentation

How are dark circles under the eyes treated?

Treatment of dark circles under the eyes depends on its nature. General measures include:

  • Adequate sleep
  • Smoking cessation
  • Sleep with extra pillows to elevate head and reduce eyelid swelling
  • Massage temporary swelling while applying a cold compress
  • Cold compresses also minimise the appearance of prominent blood vessels
  • Cosmetic camouflage
  • Light-reflecting concealers (these are often yellow or gold in colour) covered by translucent face powder. These should be applied in the shadows, not on the puffy skin

Unfortunately, many of the remedies on the market lack evidence of efficacy.

Medical treatments to reduce pigmentation can include:

Loss of tissue (hollowing) and tear trough can be managed by aesthetic medical and surgical procedures:

Considerable training and experience is required to optimise results. Improvement may be partial. Incorrect technique may make the dark circles look more prominent that before the procedure.

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